Improving the cancer early detection provided to minority and low income patients is and important challenge. The potential role of intermediary organizations in this is largely unexplored. This Project would test the impact of interventions previously shown to be efficacious elseware in improving physician cancer early detection activities provided by a defined population of physicians working in federally supported Community Health Centers for low income patients in US DHHS Region II. The Clinical Directions Netwokr of Region II is a professional organization serving the clinical leadership of these Centers and would serve as the intermediary. Patients served include over 70% who are Hispanic of black. During the first three years of the Project, 60 sites will be assigned to receive either the Minimal or the Definitive intervention with evaluation of the impact over twenty four months on physician recommendation and performance of Pap tests, mammograms, stool occult blood testing, sigmoidoscopy, self breast examination and clinical oral cavity, breast, and digital rectal examinations. The remaining 60 sites will receive the best intervention in the fourth year of the Project. Overall, a defined population of 550 physicians will be involved. The Minimal intervention will inform assigned Center Clinical Directors of the NCI Working Guidelines for Early Cancer Detection and their rationale. The Definitive intervention will, in addition, provide specific training for assigned Center Clinical Directors in : 1) educating their physicians and staff in encouraging adoption of the NCI Guidelines; 2) desgining and implementing an office system to help maintain provision and quality of cancer early detection activities; and 3) motivating Center patients to be receptive to early detection services. At baseline and over 24 months thereafter, evaluation will address both services performed and the process of offering the services through 3000Patient Exit Interviews, 3000 Record Reviews, and Physician and Office Staff Questionnaires. This project will provide new insights into the cancer early detection services provided to low income patients, ways to improve them, and the role of intermediary organizations.